Breast conserving surgery is increasingly performed in early stage breast cancer patients. A certain propotion of these patients are at substantial risk for systemic metastasis. However, there is no valid consensus about optimal sequencing of chemotherapy and radiation therapy. We conducted a randomized prospective study to investigate whether concurrent chemotherapy and radiation therapy after breast conservation surgery are associated with increased toxicity. Fifty-seven patients with stage I or II breast cancer were randomly assigned to receive CMF chemotherapy either simultaneously (n=37) or before (n=20) radiation therapy. Moist desquamation was the most common adverse effect which occurred in 46% (16/37) treated with concurrent chemotherapy and radiation therapy while 8 patients (38%) treated with sequential regimen had the finding. Difference between two groups was not statistically significant. Incidence of severe neutropenia (WBC>1,800) or abnormal elevation of liver enzymes was also not influenced by sequencing of adjuvant therapies. Arm edema was observed in 2 patients of concurrent group and was observed in 2 patients treated with sequential regimen. Two patients treated with concurrent regimen did not complete 6 cycles of chemotherapy while one patient with sequential regimen did not complete. Incidence of toxicity during chemotherapy was not altered by timing of radiation therapy. In conclusion, chemotherapy and radiation therapy can be given concurrently after breast conservation surgery in stage I or II breast cancer patients without increase of serious toxicity.
Arm ; Breast Neoplasms* ; Breast* ; Consensus ; Drug Therapy* ; Edema ; Humans ; Incidence ; Liver ; Mastectomy, Segmental ; Neoplasm Metastasis ; Neutropenia ; Prospective Studies

BACKGROUND: The bone mineral densities of men decrease with increasing age like women. The incidence of osteoporosis gradually increase according to increasing proportion of older people, but the studies on osteoporosis of men are now beginning. The association between the bone mineral density and behavioral factors among adult men in Korea were studied. METHODS: The study subjects who visited health promotion center of one hospital located in Seoul from April to May 2001, aged 28 to 76 years, were all mearsured bone mineral density at left calcaneus using quantitative ultrasonography (QUS). We interviewed all subjects to get the information about past medical history and behavioral risk factors such as smoking, drinking, intake of dairy food, and exercise patterns. We also checked height, weight, blood chemistry including alkaline phosphatase and Prostate Specific Antigen. We calculated the Pearson's partial correlation coefficient between Speed of Sound (SOS) and each variables after adjusting age and body weight, and compare the mean SOS among each categories of the variables using Analysis of Covariance (ANACOVA). Finally, multiple regression analysis was done, using the model including significant variables of baseline analysis. RESULTS: One hundred six men, who did not have any metabolic disease influencing bone mineral density, were included. Age and smoking amount were negatively correlated and body weight was positively correlated with SOS. In univariate analysis, exercise, past history of fracture and dairy food intake was significantly associated with bone mineral density of men. In multiple regression analysis, body weight and dairy food intake were positively associated, but age and smoking amounts were negatively associated with bone mineral density. CONCLUSION: To increase bone mineral density of men, one should maintain adequate body weight, ingest dairy food regulary and reduce smoking amount or quit smoking.
Adult* ; Alkaline Phosphatase ; Body Weight ; Bone Density* ; Calcaneus ; Chemistry ; Drinking ; Eating ; Female ; Health Promotion ; Humans ; Incidence ; Korea* ; Male ; Metabolic Diseases ; Osteoporosis ; Prostate-Specific Antigen ; Risk Factors ; Seoul ; Smoke ; Smoking ; Ultrasonography

Chemotherapy offers palliative treatment to patient with advanced nonresectable hepatoma. The usefulness of systemic chemotherapy is limited becaused of serious side reaction and low concentration of drug at tumor. Butthis problem may be overcome by intraarterial infusion. Nonsurgical percutaneous hepatic arteiral catheterizationwas done in 21 patients with primary hepatoma, and infusion chemotherapy was done in 19 patients who were successful in catherization. The results were as follows; 1. Selective catheterization of hepatic artery proper,common hepatic artery, and celiac artery were seccessful in 4, 9 and 4 patients, respectively. The success rate ofselective catheterization is 80.9% including celiac artery among 21 patients with hepatoma. 2. Simple catherization method was applied in 14 patients, and catheter exchange and Loop methods were applied in 2 and 1patient respectively. 3. Complications related to catheterization, such as infection and bleeding on punctured site, intimal injury and dislodgement of catheter were not serious. 4. Drugs were well tolerated without serioustoxicity or complication. 5. 3 patients showed objective response and median survival time of treated patients is 2.5 months.
Carcinoma, Hepatocellular ; Catheterization ; Catheters ; Celiac Artery ; Drug Therapy ; Hemorrhage ; Hepatic Artery ; Humans ; Infusions, Intra-Arterial ; Methods ; Palliative Care

BACKGROUND: Automated counting of reticulocyte introduced new reticulocyte parameters such as immature reticulocyte fraction (IRF). IRF is thought to be more sensitive than absolute or corrected reticulocyte count for detecting recovery of bone marrow function. The aim of this study is to assess the role of IRF for predicting the response of therapy after treatment of iron deficiency anemia. METHODS: Patients with previously untreated iron deficiency anemia (blood hemoglobin <10.0g/dL and serum ferritin <10ng/mL) were enrolled into this study. On the 8th day of iron therapy, Complete blood count (CBC) with reticulocyte count and IRF was assessed by RAM-1 reticulocyte autoanalyzer (Sysmex. Tokyo, Japan). IRF was defined as sum of the reticulocyte fraction of high-fluorescence intensity regions plus the fraction of middle fluorescence intensity regions. After 1 month of iron therapy, CBC was reassessed to evaluate the response of iron therapy. The correlation of the 8th day IRF and the change of hemoglobin level after 4 weeks of therapy was evaluated. The 8th day corrected reticulcyte count was also evaluated. RESULTS: From Jan. 2001 to May 2003, 27 patients with iron deficiency anemia (3 men and 24 women) entered into this study. We evaluated 21 patients, excluding 6 patients who were lost to follow-up or refused blood sampling after 1 month of iron therapy. The range of pretreatment hemoglobin level was 3.3-9.7g/dL (median 7.5g/dL). The 8th day IRF was 0.06-0.39 (median 0.15). Ten patients had the low IRF (IRF < or = 0.15). Four of them (40%) had their hemoglobin level increased by more than 3g/dL. On the other side, 11 patients had high IRF (IRF>0.15) and 10 of them (91%) had their hemoglobin level increased by more than 3g/dL. This difference was significant (P=0.024). However, the 8th day IRF was not correlated with the change of hemoglobin as strongly as the 8th day corrected reticulocyte count (Pearson coefficient 0.420 vs 0.693). CONCLUSION: For the patients with iron deficiency anemia, the 8th day of treatment IRF correlates with the response of iron treatment, but the 8th day of treatment corrected reticulocyte count has a stronger correlation.
Anemia, Iron-Deficiency* ; Blood Cell Count ; Bone Marrow ; Ferritins ; Fluorescence ; Hemoglobin A ; Humans ; Iron* ; Lost to Follow-Up ; Male ; Reticulocyte Count ; Reticulocytes*

PURPOSE: Breast conserving surgery is increasingly performed in early stage breast cancer patients. A certain propotion of these patients are at substantial risk for systemic metastasis. However, there is no valid consensus about optimal sequencing of chemotherapy and radiation therapy. METHODS: We conducted a randomized prospective study to investigate whether concurrent chemotherapy and radiation therapy after breast conserving surgery are associated with increased toxicity. Fifty-seven patients with stage I or II breast cancer were randomly assigned to receive CMF chemotherpy either simultaneously with (n=37) or before (n=20) radiation therapy. RESULTS: Moist desquamation was the most common adverse effect which occurred in 46% (16/37) of the patients treated with concurrent chemotherapy and radiation therapy and 40% (8/20) of those treated with the sequential regimen. This difference between two groups was not statistically significant. Also the incidence of severe neutropenia (WBC<1,800) or abnormal elevation of liver enzymes was not influenced by the sequencing of the adjuvant therapies. Arm edema was observed in 2 patients of the concurrent group and in 2 patients of the sequential regimen. Two patients treated with the concurrent regimen did not complete 6 cycles of chemotherapy while only one patient treated with sequential regimen did not. The incidence of toxicity during chemotherapy was not altered by the timing of radiation therapy. CONCLUSION: Chemotherapy and radiation therapy can be given concurrently after breast conserving surgery in stage I or II breast cancer patients without increase in serious toxicity.
Arm ; Breast Neoplasms* ; Breast* ; Consensus ; Drug Therapy* ; Edema ; Humans ; Incidence ; Liver ; Mastectomy, Segmental ; Neoplasm Metastasis ; Neutropenia ; Prospective Studies ; Radiotherapy*

Epithelioid hemangioendothelioma is a rare vascular neoplasm characterized by epithelioid tumor cells and borderline biologic behavior. We present a case of grade III malignant epithelioid hemangioendothelioma of the skull and brain parenchyme in a 58-year-old female. The tumor consisted of loose aggregates of epithelioid cells with a focal small nest pattern and tumor cells displayed frequent intracytoplasmic vacuoles and contained areas with significant atypia and mitotic activity(more than 2/10 HPF). Immunohistochemically, the tumor cells showed positive staining for facor VIII-RGA and vimentin. Radiological and histopathologic characteristics of this tumor with a review of pertinent literature is presented.
Brain ; Epithelioid Cells ; Female ; Hemangioendothelioma, Epithelioid* ; Humans ; Immunohistochemistry ; Magnetic Resonance Imaging ; Middle Aged ; Skull ; Vacuoles ; Vascular Neoplasms ; Vimentin

Subdural empyema of the brain is an uncommon disorder that occurs more frequently in children than in adult. Authors report a very rare of subdural empyema following the subdural hygroma after mild head injury. The exact mechanism of infection is not known. However, we have to consider subdural infection as one of differential diagnosis in elderly patient with subdural hygroma when new abnormal density lesion is developed in the subdural space.
Adult ; Aged ; Brain ; Child ; Craniocerebral Trauma ; Diagnosis, Differential ; Empyema, Subdural ; Escherichia ; Escherichia coli ; Humans ; Subdural Effusion ; Subdural Space

BACKGROUND: There are a few studies on the effects of job strain on the prevalence of sleep problems in the foreign countries. In Korea, it has not been studied till now. In this article, the combined effects of job strain, shift work and some life style on the prevalence of sleep proplems were studied among workers in middle aged men. METHODS: 998 cases were chosen from 1109 men who visited health screening center from October to November, 1999. Sleep problems were categorized to insomnia, sleep deprivation, daytime sleepiness and snoring on the base of result of factor analysis of 11 questions. Job strain was measured by 11 questions which developed by Karasek and Theorell. All data set were analyzed using Chi square test and multiple logistic regression analysis. RESULTS: The 4 sleep proplems were analyzed by multiple logistic regression analysis in relation to job strain, shift work, occupation, obesity, sedentary life style, smoking, drinking. Insomnia was increased significantly from highest job strain group(Odds ratio (OR:2.02)) and non exercise group(OR:2.05). In these groups, daytime sleepiness was increased significantly(OR=1.92 in the highest job strain group, OR=1.72 in non exercise group). Sleep deprivation was increased in the highest job strain group(OR=2.18), managers & clerks(OR:1.67) and non exercise group(OR:1.78). Snoring was increased from BMI(Body mass index)> OR =25(OR=1.77), BMI> OR =27(OR=2.80) and non exercise group(OR:1.87). CONCLUSION: In the highest job strain group, insomnia, sleep deprivation and daytime sleepiness was increased significantly. And sedentary life style increased all sleep problems.
Dataset ; Drinking ; Humans ; Korea ; Life Style* ; Logistic Models ; Male ; Mass Screening ; Middle Aged* ; Obesity ; Occupations ; Prevalence* ; Sleep Deprivation ; Sleep Initiation and Maintenance Disorders ; Smoke ; Smoking ; Snoring

BACKGROUND AND OBJECTIVES: Several echocardiographic methods, such as ejection fraction, fractional shortening, and Doppler tissue imaging (DTI), have been developed to quantify systolic function but all had several important limitations. The purpose of this study was to quantify the regional wall motion abnormality, using strain, in an acute myocardial infarction, compared with a visual estimation. SUBJECTS AND MEHTODS: Forty-five patients, with acute anterior (n=28) and inferior myocardial (n=17) infarctions, who underwent color DTI, were examined using longitudinal strain and standard echocardiography, and the results were compared with 54 normal controls. A total of 594 segments [3 segments (apical, mid and basal portion) of septum and inferior wallx99 patients] were evaluated. RESULTS: In the normal control group, the strain was uniformly distributed in all segments (-20%~-23%). In the infarction groups, the strain was negatively related with the wall motion score. The strain of the apical segments and mid-septum was decreased in the anterior wall infarctions, and the strain of basal septum and mid to basal inferior wall was decreased in the inferior wall infarctions. The dyskinetic segments showed positive strain. CONCLUSION: This study validates strain as a superior method for the quantification of the regional wall motion abnormality in an acute myocardial infarction than visual estimation.
Echocardiography ; Humans ; Infarction ; Myocardial Infarction*

BACKGROUND AND OBJECTIVES: Multiple Endocrine Neoplasia type 2A (MEN 2A) is a syndrome that encompasses medullary thyroid carcinoma, pheochromocytoma, and hyperparathyroidism. Since MEN 2A is inherited as autosomal dominant, early detection and treatment is crucial. A genetic analysis of RET proto-oncogene of the family members of an index patient diagnosed as MEN 2A is reported. SUBJECTS AND METHOD: A patient diagnosed as MEN 2A and his 13 family members across two generations were studied. Initially, DNA was extracted from the peripheral blood leukocyte of family members and PCR amplification of exons 10, 11, 13, 14, 15, and 16 was performed, followed by investigation of point mutation on the RET proto-oncogene using a DNA sequence analyzer. Cervical ultrasonography was carried out in the 3 nephews who were revealed to have RET proto-oncogene point mutation. RESULTS: Point mutations of TGC (cys) to TGG (Trp) at codon 634 of exon 11 at RET proto-oncogene was detected by using automatic DNA sequence analyzing method in the index patient. The same point mutation was identified in 7 of the 13 family members. Cervical ultrasonography revealed bilateral thyroid nodules in all 3 nephews who had point mutations of RET proto-oncogene. CONCLUSION: With the genetic analysis of RET proto-oncogene, limitations of the conventional calcitonin stimulation test may be overcome, and a more complete approach can be achieved through early diagnosis by carrying out this screening test for point mutations in family members of the patient with MEN 2A.
Base Sequence ; Calcitonin ; Codon ; DNA ; Early Diagnosis ; Exons ; Family Characteristics ; Humans ; Hyperparathyroidism ; Leukocytes ; Mass Screening ; Multiple Endocrine Neoplasia Type 2a* ; Multiple Endocrine Neoplasia* ; Pheochromocytoma ; Point Mutation* ; Polymerase Chain Reaction ; Proto-Oncogenes ; Thyroid Neoplasms ; Thyroid Nodule ; Ultrasonography